Mental Health and Gun Violence Summit

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How we are changing the conversation and policies on mental health & gun violence

Upon passage of I-1491 (Extreme Risk Protection Orders) in November 2016, Washington became one of a handful of states with this life-saving law on the books. In addition to legislative roadblocks, crafting the policy presented its own challenges. One recurring challenge was educating the public that the real risk of those who are a danger to themselves and to others is based on behavioral indicators, not a mental illness diagnosis. The Alliance is dedicated to continuing the hard work of destigmatizing those living with mental illness and to supporting effective, data-driven policies and interventions where mental health issues meet firearm ownership.

Mental Health and Gun Violence Summit

June 20, 2017: The Alliance for Gun Responsibility Foundation hosted a day-long Summit bringing together state and national GVP and mental health experts to present the latest research on the intersection of mental health and gun violence. We also invited legislators into the mix, to host a candid discussion about how to create effective policy without further stigmatization of those living with mental illness.

For our gathering, attended by upwards of 60 mental health providers, public health employees and GVP advocates, we set out to reframe the real risks for interpersonal violence, address the suicide epidemic, and present effective intervention approaches. It was a day of compassionate learning, breaking down barriers, and focusing on policies and programs that move the needle on gun violence.

Experts in the GVP field presented compelling data

Josh Horwitz , Executive Director of the Educational Fund to Stop Gun Violence, delivered a powerful keynote presentation. (EFSGV is a DC-based organization, a close national partner to the Alliance, focusing on public health, evidence-based approaches.) A few key take-aways:

Suicide as a percentage of total firearms deaths in WA state is 75%, compared to 61% nationally.

Serious mental illness on its own contributes very little to overall violence towards others, just 4% of total. In the case of suicide however, up to 47-74% of violence towards self is attributable to serious mental illness alone.

Case-control studies in the US have found the presence of a firearm is a strong risk factor for suicide.

Success of policies to restrict firearm access to those in crisis work, e.g. Connecticut’s Risk Warrant law of 1999, show that for every 10-20 warrants issued, one life is saved.

National and state-based experts Jessyca Dudley from the Joyce Foundation’s Gun Violence Prevention Program and Mamadou Nyiade from the Washington State Department of Health followed, presenting firearms fatality data from national and state perspectives.

Nationally speaking, data collection and research on gun violence is relatively low (due to effective CDC research ban); key data sources are the National Violent Death Reporting System and National Electronic Injury Surveillance System.

Burden of gun violence translates to 10 deaths per 100,000, now exceeding the rate for motor vehicle deaths.

States with more guns have higher rates of homicide and suicide, states with stricter gun control laws have fewer deaths from gun violence.

Research shows those with serious mental illness arrested for violent gun crime or completed suicide with a gun: 72% who completed suicide were not prohibited, 38% arrested for a violent crime were not prohibited.

On a state level, much progress has been made on data collection:

75% of firearm deaths in Washington are by suicide.

King County has one of the lowest firearm death rates. Clallam, Ferry, Stevens, and Pend Oreille are among the highest in WA.

Demographic breakdown for suicide by firearm:

Race (2006-2015): White (50%), Hispanic (47%), Black (42%)

Sex: Female (28%), Male (54%)

2010 – 2014 state rate for firearm injury: 52.3 deaths per 100,000

WA Violent Death Reporting System began in 2015 with 9 participant counties. In 2017, 25 counties (95% of violent death cases) will be reached, and by 2018 the whole state will be covered.

State legislators shared their perspectives

Opening remarks were delivered by Senator Patty Kuderer from the 48th Legislative District, who spoke to the historically immense challenges of a divided legislature on gun violence prevention policy.

Interestingly enough, Sen. Kuderer pointed out, with the inclusion of mental illness/mental health to these policies, there is more willingness to have a conversation and work together across the aisle. Senator Kuderer was the Prime Sponsor of Senate Bill 5441, which would prohibit a person from possessing or purchasing a firearm for six months following a 72-hour involuntary hold. It received a hearing in the Senate, which represents a major step forward, and though it didn’t progress, Senator Kuderer plans to bring the bill back next legislative session.

This TED-Talk style discussion centered on how to create effective legislation without marginalizing those living with mental illness. Firearm ownership is a civil rights issue for those with mental health concerns – this reality has the potential to create conflict between mental health and gun violence prevention advocacy.

An example of this potential conflict was NAMI WA’s neutral stance on Initiative 1491 due the language of mental illness diagnosis in the Initiative (language cannot be changed or negotiated once an Initiative is filed).

From the legislator perspective, two key challenges were discussed:

1. NRA inclusion in discussions around bills dealing with the intersection of mental health and firearms. For instance, the NRA questioned why Senate Bill 5441 did not include chemical abuse if it’s a suicide prevention bill. For Senator Kuderer, the reasoning was the instantaneous versus prolonged death aspect – without immediate intervention if firearms are present, the odds of fatality are much higher.

2. The amount of work required just to get a policy passed, which means implementation details are not laid out – if they were, it would kill the policy. So it’s a constant balancing act, and ultimately all about incremental steps.

Group concensus was that the key to future legislative success is the messaging of “safety laws” that don’t further stigmatize those living with mental illness and make clear that prevention measures such as Senate Bill 5441 are not about taking people’s guns away – they’re simply about removing access to firearms during a critical period.

This panel discussion revolved around interventions at multiple levels. At the community level, lethal means counseling programs, such as Means Matter, establish the role of firearms in suicide (where the risk IS the firearm) and the Gun Shop project, where gun owners are trained to recognize the signs of suicide in a potential purchaser.

A bulk of the panel discussion centered on the individual/relationship levels of the social/ecological suicide prevention model (click and diagram pops up). Involving family is key to successful interventions, working with members to form a plan based on questions such as: Is there a time that it would be a risk to have a firearm around? How would you recognize that time? What should we do if you have/see these warning signs, what is the plan? Psychiatric advanced directives can also be a very useful tool in developing these plans.

It was established that the clinician’s dual role is critically important: maintaining a collaborative patient relationship while simultaneously reducing risk. It was also noted how important it is to normalize the idea there isn’t a “dangerous box” into which you can place people and therefore predict who is most at risk for suicide – means restriction planning is a smart thing for everyone.

The panel closed touching on Extreme Risk Protection Orders as a tool, which for the two clinicians on the panel, is a second order effect. Clinicians are obligated to report identifiable acute risk, creating an opportunity to ensure law enforcement is aware of ERPO. This second order effect of ERPO counseling also applies to families, as clinicians move to a more effective family support model.

Breakout sessions provided in-depth learning

Presenting the Extreme Risk Protection Orders use process is Eileen Norton, part of the ERPO implementation team. To her left (seated) is co-presenter and fellow implementation team member Anne Levinson, and to her right is Milena Stott, Chief of Inpatient Services at Valley Citites Behavioral Health.

During the second half of our day-long Summit, participants attended two of four breakout sessions offered:

Community impact of mental health and gun violence intersection, the clinician’s perspective on secondary trauma. (Discussion)

From Policy to Practice and Practice to Policy: use of Extreme Risk Protection Orders, the clinical and legal perspectives. (Presentation).

“Safety Assessments” for individuals with mental health diagnoses including PTSD, substance use disorders, mood/anxiety or psychotic disorders in populations with a very high rate of gun ownership. (Discussion)

The second session on Extreme Risk Protection Orders took the audience through the complete process of filing a petition to the surrender of firearms. With a clinician co-leading the session, the presentation incorporated ERPOs as part of safety planning for at-risk individuals.